Provider Demographics
NPI:1487202479
Name:PLUMMER, TARYN L (APN)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:L
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5904
Mailing Address - Country:US
Mailing Address - Phone:217-588-2600
Mailing Address - Fax:217-588-7483
Practice Address - Street 1:2950 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5904
Practice Address - Country:US
Practice Address - Phone:217-588-2600
Practice Address - Fax:217-588-7483
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041364029OtherRN LICENSE